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Sunday Poster Session

Category: Interventional Endoscopy

P0842 - The Role of Angiography and Coil Embolization for Diagnosis and Management of Splanchnic Artery Pseudoaneurysms in Patients with Pancreatitis

Sunday, October 22, 2023
3:30 PM – 7:00 PM PT
Location: Exhibit Hall

    Presenting Author(s)

  • Akash Khurana, MD

    Case Western Reserve University, University Hospitals
    Cleveland, Ohio

Akash Khurana, MD1, Vibhu Chittajallu, MD2, Christopher Sutter, MD1, Ashley Faulx, MD2, Amitabh Chak, MD2, Brooke Glessing, MD2
1Case Western Reserve University, University Hospitals, Cleveland, OH; 2Digestive Health Institute, University Hospitals Cleveland Medical Center, Cleveland, OH

Introduction: Splanchnic artery pseudoaneurysms are an adverse event of necrotizing pancreatitis and walled-off necrosis (WON), which can carry significant morbidity and mortality. We hypothesize that risk of pseudoaneurysm bleeding is lower prior to cystgastrostomy for WON due to the tamponade effect of the WON on adjacent pseudoaneurysm. However, there is limited data to suggest prophylactic embolization of pseudoaneurysms to reduce this bleeding risk.

Methods: We performed a retrospective case-series to evaluate outcomes for patients that underwent coil embolization of pseudoaneurysm before or after cystgastrostomy.

Results: Our study included seven patients, of which four had an embolization prior to cystgastrostomy and three had an embolization after. Of the four that underwent embolization prior to cystgastrostomy, two required red blood cell transfusions for hemorrhagic anemia, one had recurrent hemorrhage after embolization, one required ICU admission, and one died. One patient required upper endoscopy for endoscopic treatment of bleeding and zero patients required repeat angiography or embolization to control bleeding. Of the three that underwent embolization after cystgastrostomy to control bleeding, all three patients required transfusions, three required ICU admission, one had recurrent hemorrhage after embolization, and one died. Two patients required upper endoscopy for endoscopic treatment of bleeding and one required repeat angiography with embolization for recurrent hemorrhage. Diagnostic accuracy of index imaging was low (four out of seven did not have evidence of pseudoaneurysm on CT or MR index imaging). Three of these four patients required angiography for a diagnosis of pseudoaneurysm and two out of these four died from uncontrollable hemorrhage.

Discussion: We query the role of utilizing IR-guided angiography for diagnosis and treatment of pseudoaneurysm prior to cystgastrostomy.

Figure: Figure 1. Chronologic trends in hemoglobin between each patient’s baseline, date of admission, embolization, endoscopic drainage, and date of discharge (all presented in units of g/dL)
Case NumberIndex Imaging ModalityLocation of WONSize (cm)Pseudoaneurysm present on initial imaging?Imaging type for diagnosis of pseudoaneurysmArtery with pseudoaneurysmType of initial cystgastrostomy stentTime interveal between embolization and cystgastrostomy (days)Did the patient have multiple follow-up necrosectomies?ICU admissionDeathOther adverse events
1CTATail15.0 x 10.0YesCTASplenicLAMS44YesNoNoPancreatic duct stricture requiring stent placement
2CTATail10.0 x 7.2NoAngiographySplenicPigtail1277YesNoNoMultifocal arterial thromboses, retroperitoneal hematoma
3MRATail9.0 x 7.4YesMRASplenicPigtail7NoYesYesSpontaneous bacterial peritonitis, recurrent ascites requiring large-volume paracentesis
4CTABody4.7 x 4.2YesCTASplenicLAMS253YesYesNoPancreatic duct stricture requiring stent placement
5CTATail22.7 x 13.9NoAngiographySplenicLAMS7YesYesYesGastric variceal hemorrhage, severe malnutrition
6CTATail9.2 x 7.2NoAngiographySplenicLAMS12YesYesNoNone
7CTABody19.2 x 16.0NoCTAGastroduodenalLAMS26YesYesNoCystocolonic fistula and retroperitoneal abscess requiring percutaneous drainage

Table: Disease-specific details including imaging studies and findings, procedural details, and patient outcomes/adverse events including ICU admission and death


Disclosures:
Akash Khurana indicated no relevant financial relationships.
Vibhu Chittajallu indicated no relevant financial relationships.
Christopher Sutter indicated no relevant financial relationships.
Ashley Faulx indicated no relevant financial relationships.
Amitabh Chak indicated no relevant financial relationships.
Brooke Glessing indicated no relevant financial relationships.


Akash Khurana, MD1, Vibhu Chittajallu, MD2, Christopher Sutter, MD1, Ashley Faulx, MD2, Amitabh Chak, MD2, Brooke Glessing, MD2. P0842 - The Role of Angiography and Coil Embolization for Diagnosis and Management of Splanchnic Artery Pseudoaneurysms in Patients with Pancreatitis, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.